接受扩血管药物治疗的患者应当检查中心动脉压,因为可以正确评价降压作用,而通过常规的肱动脉血压测定会低估降压作用。另外,有心脏病的患者应当检查中心动脉压,因为可以得到有关心脏后负荷的确切信息。
International Circulation: It has been reported that compared with diuretics and β-blocker, CCB and ACEI/ARB do a better job of reducing central blood pressure. Does that mean CCB and ACEI/ARB should be given priority in antihypertensive treatment?
Takazawa:Yes, I think so.
Vasodilator agents reduce mainly late systolic pressure which increases with increasing arterial stiffness and causes cardiac afterload. On the other hand, diuretics and β-blocker mainly reduces the ejection pressure. So, for the purpose of reduction in cardiovascular accidents in hypertensive patients, I do believe that vasodilator agents must be used as first choice of treatment.
《国际循环》:有报道显示,与利尿剂和β阻滞剂相比,CCB和ACEI/ARB能够更有效地降低中心动脉压。这是否意味着降压治疗应优先选择CCB和ACEI/ARB?
Takazawa教授:是的。扩血管药物主要降低晚期SBP,晚期SBP升高会增加动脉僵硬度和心脏后负荷。另一方面,利尿剂和β阻滞剂主要降低心室射血时的血压,因此为了达成减少高血压患者心血管事件的目的,我的确认为应当将扩血管药物作为一线治疗。